Epic Systems is the number one vendor when it comes to physician EHR adoption, but it only barely beats out some of its close competitors for the top spot, according to a report from SK&A. While the mega-vendor is a frequent choice for large hospitals and health systems, taking best-in-show honors from KLAS Research for nine out of the past ten years, Epic has not yet secured total dominance on the physician side. The highly fragmented market has left a number of other vendors nipping at Epic’s heels, including eClinicalworks, Allscripts, and Practice Fusion, which have secured similar shares of the top 35% of physician customers.

In contrast to last year’s report, where the top ten vendors made up 53% of the physician EHR adoption market, this year’s research shows that just eight vendors have now scooped up the same proportion of providers. Epic, now at 11.6 percent of the overall market, has grown by more than 1 percent over last year’s numbers, while eClinicalworks has stayed steady at 10.2 percent, and Allscripts follows at 8.7 percent.

The next few vendors, including Practice Fusion, NextGen, GE, and Cerner, drop off from 6.7 percent to 3.5 percent, while other companies, including athenahealth, McKesson, Greenway, and MEDITECH, hover between one and two percent of market share. Overall adoption has increased from 61 percent to 62.8 percent of all responding providers, the report shows.

Quite notably, the top twenty vendors make up less than three-quarters of the physician EHR market. Twenty-seven percent of providers are using close to 500 different products that may be proprietary, specialty-specific, or small newcomers in the industry. Providers with one to three physicians were significantly more likely to be using one of these unknowns than larger organizations, with close to 30% of these small organizations adopting a product outside of the mainstream.

The fragmentation of the EHR landscape is a boon for startup developers and smaller companies looking to cash in on the few remaining paperbound providers, or those seeking to become an unhappy organization’s choice for a replacement EHR. But it is also bad news for health IT interoperability, as small vendors who may or may not be certified by the ONC for meaningful useattestation, are built upon a wide array of proprietary technologies that do not foster data exchange.

While a 2013 survey found that small EHR vendors were more likely than larger ones to produce happy customers, likely due to better customer support and more individualized attention for training and technical glitches, these vendors may also be more likely to fold suddenly under financial pressures, leaving physician organizations in the lurch.

But financial disasters are not the provenance of small vendors alone. Epic has made more headlines than most other vendors for its role in several spectacular EHR implementation failures, though it is most frequently cited for its success in larger hospitals, and continues to expand its footprint into major health systems. The Mayo Clinic recently announced that the vendor would be replacing Mayo’s trio of EHR systems with a single, integrated platform, while Epic remains in contention for the $11 billion Department of Defense EHR modernization contract. The company’s suite of offerings, including business intelligence software, ambulatory practice management, health information exchange, and patient portals provides physician practices with an attractive toolkit to fuel expansion into the physician EHR world.

Other companies are seeking a similar crossover between the ambulatory and hospital markets as adoption reaches its saturation point. athenahealth, ranked eighth in physician EHR market share by SK&A, is moving into the hospital sphere by offering its cloud-based services to the rural and critical access hospital (CAH) market.

“Rural and CAH organizations may not receive the same attention as academic medical centers and large, clinically-integrated health systems, but they make up approximately 1/3 of the hospital market,” explained Jeremy Delinsky, Chief Technology Officer at athenahealth. “They’re also innovative, important pillars of their communities, providing tremendous value and quality at generally lower costs. These providers have been unable to afford the steep price tags of legacy software installations. Our revenue model is closely tied to that of our customers; we don’t make money unless they succeed. We think this message will gain a lot of traction in the CAH market. From there, we will have room to climb upmarket.”

EHR vendors looking to achieve a foothold in both worlds will need to tailor their offerings appropriately for customers no longer satisfied with basic data entry interfaces. While some companies tout the standardization of their user experiences as a selling point, products that will continue to gain traction in either segment of the marketplace will need to meet the specific needs of choosy providers looking to make the most of their costly EHR investments.

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